1 June 2015

Jane McCredie: Live a little

“YOU’D think people would have burnt the nursing homes to the ground”, writes New York surgeon Dr Atul Gawande in his book, Being Mortal.

The reason we haven’t, he writes, is because we lack the imagination to find a better way of caring for old people, a way to “make life worth living when we’re weak and frail and can’t fend for ourselves any more”.

Speaking at the recent Sydney Writers’ Festival, Dr Gawande questioned why people seeking residential care for an elderly parent so often stressed safety above any other consideration.

“Will my mother be safe here?” was the frequently asked question.

He has a point. Basic safety matters, of course, but few of us would see it as a sufficient end in itself when it comes to our own lives.

What about fulfillment? Interest? Happiness? Even excitement?

Too often, we deny the elderly the right to take risks, despite cherishing that right for ourselves.

A member of my extended family, for example, had a grandson smuggle whisky into her aged care home so she could sneak a glass or two of an evening — a pleasure lost to her when she became too frail to get the forbidden bottle from its hiding place.

We don’t deny the right of an 18-year old to drink themselves into oblivion, but we’re just not comfortable with an 80-year old making the same choice.

Denying the right to take risks is a kind of infantilisation, a statement that somebody cannot be allowed to take responsibility for decisions about their own life.

In nursing homes, Dr Gawande writes, this often becomes a battle about food.

“A woman with Parkinson’s disease keeps violating her pureed diet restrictions, stealing food from other residents that could cause her to choke. A man with Alzheimer’s disease hoards snacks in his room, violating house rules. A diabetic is found eating clandestine sugar cookies and pudding, knocking his blood sugar levels off his target.”

The response to these small rebellions varies, he writes.

“In the horrible places, the battle for control escalates until you get tied down or locked into your Geri-chair or chemically subdued with psychotropic medications. In the nice ones, a staff member cracks a joke, wags an affectionate finger, and takes your brownie stash away.”

Why, Dr Gawande asked at the festival, couldn’t nursing homes have a communal kitchen at their focal point, instead of a nurses’ station? And why not a fridge that residents could access whenever they wished?

If a resident with diabetes chose to go on a sugar binge, didn’t he have the same right to take that risk as any other person with diabetes?

It’s true that an elderly person with dementia may not be able to fully assess the risks of their behaviour, but aged care tends to remove the right to autonomous decision-making even from those with excellent cognitive function.

There are many reasons for this aversion to risk-taking behaviour: the fear of being sued if a resident’s choices have adverse consequences for their health, staff’s desire to control the behaviour of “difficult” residents, and genuine concern for the welfare of vulnerable people.

But surely we can do better than stripping the autonomy of adulthood from people nearing the end of life?

A friend’s great-aunt celebrated her 90th birthday by doing her first parachute jump. There should be more of it.

Jane McCredie is a Sydney-based science and medicine writer.

Poll

Should elderly people in nursing homes be given the freedom to make risky decisions?

4 thoughts on “Jane McCredie: Live a little”

Couldn’t agree more! Before we even become incarcerated in Stalag Luft 7 we are inundated with messages to the “oldies”. Here in Qld we have adverts encouraging grown offspring to warn their “elderly” parents (that turns out to be over 55) to be careful when swimming or bathing, not to go fishing in small boats on their own etc etc.

I reserve the right to take what risks I want at my advanced 66 years. “It’s not the years in your life that count – it’s the live in your years”.

It does depend on Competence. A severely demented person with no insight and no legal competence should be allowed to make choices only at a level at which does not involve their own or other’s safety. But age alone has little to do with it. At the age of 85 we are planning a camping trip in Far North Queensland, and we expect to enjoy every moment. We have never wanted to go parachuting but if we did we would. Hot air ballooning in Turkey was the nearest we have come to it. We shall fiercely defend our rights to decide what we do and where we go. And when we are threatened with Loss of Competence we shall look forward to Dying with Dignity.

The cult of “health and safety” has triumphed over all. Enjoying life is a “risk” and risk reduction/harm minimisation muts take precedence over all other considerations. And if this ideology were not enough, the lawyers will be waiting to capitalise on any graze which may occur from risky behaviour like standing up.

I will soon be 90. Glad to see 2/3 of voters so far agree elderly can take risks within their known competences. Of course; it is their right as humans. A few years ago I took risks beyond my capabilities and fell on my hip heavily, causing a massive haematoma but no fracture because lifestyle changes following a coronary occlusion 25 year ago had maintained good bone density. Second lapse was a chainsaw laceration due to negligence, on the chest and penetrating to 3cm from the aorta. Yet, I switched off the saw, dropped it, pressed on the wound, walked into the house, changed out of bloodstained shorts and shirt, phoned the hospital that I was coming, described the injury, and drove there, all the time pressing firmly on the wound.

Obviously, medical experience helped, and the fact I knew I was still breathing, but also I was still competent and able to cope with an everyday emergency, as were the hospital staff.

A crucial issue is, however, is it not necessary for all people over the age of 80 to undergo, opting out if required on grounds to be determined, examination to assess ability to cope with everyday emergencies? I put this to the profession.

Ever since, commonsense has overcome in me personally the ‘ defiance of the elderly’. As long as I remain undemented I shall fight to stay away from those homes and refuges in which older people are treated like animals, in which also medical and nursing staff quickly lose their humanity.